Patient Rights, User Guides and Forms

Notice of Privacy Policy

This notice describes how health information about you (as a patient of this practice) may be used and disclosed, and how you can get access to your individually identifiable health information.  Please review this notice carefully.

New Patient

Authorize Release

If you would like our team to coordinate care with another physician practice please complete the form below to authorize release of your medical record, or the authorization for another physician practice to disclose information to us:

Patient Portal User Guides

Discrimination is Against the Law

  • English

    Discrimination is Against the Law

    Springfield Family Physicians complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  Springfield Family Physicians does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

     

      Springfield Family Physicians:

      • Provides free aids and services to people with disabilities to communicate effectively with us, such as:

       ○ Qualified sign language interpreters

      ○ Written information in other formats (large print, audio, accessible electronic formats, other formats)

      • Provides free language services to people whose primary language is not English, such as:

       ○ Qualified interpreters

       ○ Information written in other languages

      If you need these services, contact clinic manager.

    If you believe that Springfield Family Physicians has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Claire Cieri, 541-520-2052, claire@springfieldfamilyphysicians.com or claire@mardac.com. FAX: 541-689-3237. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Claire Cieri is available to help you.

    You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

    U.S. Department of Health and Human Services

    200 Independence Avenue, SW

    Room 509F, HHH Building

    Washington, D.C. 20201

    1-800-368-1019, 800-537-7697 (TDD)

    Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

  • Spanish

    Springfield Family Physicians cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Springfield Family Physicians no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo.

     

      Springfield Family Physicians:

      • Proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen de manera eficaz con nosotros, como los siguientes:

              ○ Intérpretes de lenguaje de señas capacitados.

              ○ Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros formatos).

      • Proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los siguientes:

              ○ Intérpretes capacitados.

              ○ Información escrita en otros idiomas.

     Si necesita recibir estos servicios, comuníquese con Claire Cieri.

    Si considera que Springfield Family Physicians no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad o sexo, puede presentar un reclamo a la siguiente persona: Claire Cieri, Compliance Officer 541-689-0998,  clairec@springfieldfamilyphysicians.com.  Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, Claire Cieri está a su disposición para brindársela.

    También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación:

     

    U.S. Department of Health and Human Services

    200 Independence Avenue, SW

    Room 509F, HHH Building

    Washington, D.C. 20201

    1-800-368-1019, 800-537-7697 (TDD)

    Puede obtener los formularios de reclamo en el sitio web http://www.hhs.gov/ocr/office/file/index.html.

     

     

Behavioral Health

Being healthy is more than just how you feel physically; your emotional health is important, too. Our clinic integrates behavioral health to keep your body and your mind healthy and happy.

Become a New Patient

Welcome to our family! Learn how to prepare for your first appointment, find a practitioner, and get signed up for Patient Portal.

Medical Home

We are proud to lead the way in patient-centered medical treatment as a recognized Primary Care Home.

About Us

Our mission at Springfield Family Physicians is to deliver comprehensive health care to families and individuals in the communities of Springfield, Eugene and the surrounding areas.

 

We are committed to providing accessible, affordable, high-quality medical treatment to you and your family in a timely, caring and compassionate manner. And our dedication to excellence and integrity means you will always be treated with the respect and personalized attention you deserve.

 

We know that achieving optimal health is a partnership between you and us and we look forward to working together with you in providing you the care and guidance you and your family need.

Marcola Road Clinic: 2280 Marcola Road / Springfield, OR 97477   -   Centennial Blvd Clinic: 1800 Centennial Blvd / Springfield, OR 97477

PHONE: 541-747-4300    /   BUSINESS OFFICE: 541-747-8576   /   FAX 541-747-0655

© 2015 Springfield Family Physicians